PAYMENT GATEWAY ACCOUNT SETUP FORM

Transcription

1 PAYMENT GATEWAY ACCOUNT SETUP FORM Welcme t Authrize.Net, and thank yu fr chsing us fr yur e-cmmerce transactin needs. T set up yur payment gateway accunt, please cmplete and fax the fllwing pages: Questins? Payment Gateway Accunt Setup Frm (Page 2) Authrizatin fr Single Direct Payment (Page 3) Appendix A: Merchant Accunt Cnfiguratin Frm If yu have any questins abut setting up an Authrize.Net Payment Gateway accunt, r need help determining wh prvides yur Merchant Accunt: Call Lisa Millar at Or visit the Hw it Wrks diagram at Authrize.Net, a CyberSurce slutin Attn: Lisa Millar P A G E 1 O F 6

2 ATTENTION: Lisa Millar PAYMENT GATEWAY ACCOUNT SETUP FORM Phne Number: , Fax Number: , Address: Instructins: Please fax the cmpleted setup frm t STEP 1: COMPANY INFORMATION Cmpany Name: Cmpany Officer / Owner / Principal Name: Title: Cmpany Tax ID (Sle Prp. Can use SS#): Cmpany Address (N P.O. Bxes): City: State: ZIP Cde: Cmpany Phne Number: Cmpany Fax Number: Address (The address that setup infrmatin will be sent t): Business Type (select ne): Crpratin Nn-Prfit Crpratin(must send cpy f 501c3) LLC Sle Prprietrship LLP Market Type(select ne): Card Nt Present (CNP)/E-cmmerce Mail Order/Telephne Order (MOTO) Card Present (CP)/Retail Cmpany Web Address (URL) (If yu have ne): Detailed Descriptin f Prducts r Services Sld (please be specific): Please list the name, phne number and address f yur Web develper and yur Web hsting cmpany: Web Develper: Web Hsting Cmpany: STEP 2: PAYMENT AND ACCOUNT INFORMATION Authrize.Net Payment Gateway Accunt Fees: Nn-Refundable Setup Fee*: $99.00 Mnthly Gateway Fee**: $17.95 Per-Transactin Fee**: $0.10 *Nn-Refundable Setup Fee: Cmpany agrees t pay t Authrize.Net a ne-time nn-refundable fee in the amunt written abve fr the setup f Cmpany s payment gateway accunt and access t Authrize.Net Services pursuant t the attached Authrizatin fr Single Direct Payment (ACH Debit) frm. IMPORTANT: Yu must als cmplete the AUTHORIZATION FOR SINGLE DIRECT PAYMENT frm n Page 3. **Mnthly Gateway & Per-Transactin Fee. Authrize.Net shall charge Cmpany a Mnthly Gateway Fee and Per-Transactin Fee in the amunts prvided abve. Billing shall cmmence upn the creatin f the accunt. Such fees will be billed autmatically n a mnthly basis t the bank accunt prvided n Page 3. Authrizatin. By signing belw, the individual signing this applicatin ( Applicant ) certifies, acknwledges and agrees that: (i) Applicant is an authrized principal, partner, fficer, r ther authrized representative f Cmpany that is authrized t bind Cmpany t cntractual bligatins; (ii) Authrize.Net may share infrmatin cntained in these setup frms with its service partners fr the purpse f establishing a Merchant Accunt, if applicable; (iii) billing fr the Authrize.Net Payment Gateway Accunt in the amunts set frth abve shall cmmence upn Applicant s executin belw; and (iv) Cmpany agrees t be bund by the terms and cnditins f the Authrize.Net Payment Gateway Merchant Service Agreement incrprated herein by reference and lcated at the fllwing Web address: CmpanyName: Signature: Print Name: PrintTitle Date: 2009 Authrize.Net, a CyberSurce slutin Attn: Lisa Millar P A G E 2 O F 6

3 AUTHORIZATION FOR SINGLE DIRECT PAYMENT (ACH DEBIT) The Cmpany listed belw hereby authrizes Authrize.Net LLC t initiate a debit entry t Cmpany s accunt at the depsitry financial institutin named belw and t debit the same t such accunt fr the amunt listed belw. Cmpany acknwledges that the riginatin f ACH transactins t Cmpany s accunt must cmply with the prvisins f U.S. law. PAYMENT AND ACCOUNT INFORMATION Bank Name: Accunt Type (circle ne): Checking Savings Branch City: Branch State: Zip Cde: Ruting Number (9 digits): Amunt: The amunt f the Nn-Refundable Setup Fee set frth n the Payment Gateway Accunt Setup Frm. Accunt Number: Effective Date: The date that Authrize.Net receives Cmpany s cmpleted Accunt Setup Frm and Authrizatin fr Single Direct Payment (ACH Debit). Nte: See the example belw if yu need help finding yur ruting r accunt number. This authrizatin is t remain in full frce and effect fr this transactin nly, r until such time that my indebtedness t Authrize.Net fr the amunt listed abve is fully satisfied. Print Cmpany Name: Print Crprate Emplyee Name: Signature: Date: 2009 Authrize.Net, a CyberSurce slutin Attn: Lisa Millar P A G E 3 O F 6

4 FRAUD DETECTION SUITE APPLICATION Please fill ut cmpletely and fax back t (801) Attn: Lisa Millar Our Fraud Detectin Suite (FDS) is a set f custmizable, rules-based filters and tls that identify, manage, and prevent suspicius and ptentially cstly fraudulent transactins. Yu can custmize FDS filters and tls t match yur business needs and cntrl hw suspicius transactins are handled, including the ability t apprve, decline r hld transactins fr manual review. Credit card fraud expses Web merchants t ptentially significant and nging csts. Here's hw Fraud Detectin Suite can help. Reduce Csts - Minimize and prevent authrizatin and chargeback fees as well as pssible inventry lss resulting frm fraudulent transactins. Prtect Prfits - Maximize legitimate transactins, rather than refusing business due t a fear f ptential fraud. Maximize Flexibility - Custmize filter settings accrding t yur unique business needs. Imprve Intelligence - Restrict transactin activity frm specific Internet Prtcl (IP) addresses using pwerful IP tls. Easy t use - A setup wizard guides yu thrugh the cnfiguratin prcess. FDS includes multiple filters and tls that wrk tgether t evaluate transactins fr indicatrs f fraud. Their cmbined lgic prvides a pwerful and highly effective defense against fraudulent transactins. Fraud Detectin Suite Filters: Amunt Filter - Set lwer and upper transactin amunt threshlds t restrict high-risk transactins ften used t test the validity f credit card numbers. Velcity Filter - Limit the ttal number f transactins received per hur, preventing high-vlume attacks cmmn with fraudulent transactins. Shipping-Billing Mismatch Filter - Identify high-risk transactins with different shipping and billing addresses, ptentially indicating purchases made using a stlen credit card. Transactin IP Velcity Filter - Islate suspicius activity frm a single surce by identifying excessive transactins received frm the same IP address. Suspicius Transactin Filter - Reviews highly suspicius transactins using prprietary criteria identified by Authrize.Net s dedicated Fraud Management Team. Authrized AIM IP Addresses - Allws merchant submitting Advanced Integratin Methd (AIM) transactins t designate specific server IP addresses that are authrized t submit transactins. IP Address Blcking - Blck transactins frm IP addresses knwn t be used fr fraudulent activity. Terms and Cnditins; Fees. FDS is a value-adding service designed fr yur Authrize.Net Payment Gateway accunt. Additinal fees, terms and cnditins apply. Fraud Detectin Suite (FDS) Pricing One-Time Setup Fee: $0.00 Mnthly Service Fee: $5.00 By signing belw, I reaffirm my acceptance f the terms and cnditins applicable t FDS set frth in Appendix C, Value- Adding Services, f the Authrize.Net Payment Gateway Agreement. MERCHANT: Signature: Print Name: Business Name: 2009 Authrize.Net, a CyberSurce slutin Attn: Lisa Millar P A G E 4 O F 6

5 AUTOMATED RECURRING BILLING APPLICATION Please fill ut cmpletely and fax back t (801) Attn: Lisa Millar Our Autmated Recurring Billing (ARB) is an ideal slutin if yu prvide subscriptin-based prducts r services, r wuld like t prvide yur custmers with an installment-based payment ptin fr high ticket purchases. ARB allws yu t create a "subscriptin" r recurring transactin n the payment gateway. Simply prvide the custmer's payment infrmatin, a payment schedule and the subscriptin duratin, and ARB des the rest fr yu generating subsequent transactins autmatically. Highlights f the ARB service include: Flexible billing intervals, frm weekly t annually and anything in between. Create upfrnt trial perids and pricing. Multiple methds fr creating ARB subscriptins manually in the Merchant Interface. Enter subscriptin infrmatin int a frm (similar t Virtual Terminal). Create a subscriptin based n a previus transactin. Uplad a file f subscriptin recrds. Ability fr Advance Integratin Methd (AIM) merchants t create and manage subscriptins autmatically using the ARB applicatin prgramming interface (API). Expedites the creatin and management f large vlume subscriptins. Prvides yur custmers with subscriptin r installment-based payment ptins n yur Web site payment frm. Easily integrates with prprietary slutins, eliminating the need t update r cancel subscriptins manually. In additin, with ARB, yur custmers' payment infrmatin is safely stred in ur highly secure data center, which cmplies with the Payment Card Industry (PCI) Data Security Standard. Terms and Cnditins; Fees. ARB is a value-adding service designed fr yur Authrize.Net Payment Gateway accunt. Additinal fees, terms and cnditins apply. Autmated Recurring Billing (ARB) Pricing One-Time Setup Fee: $0.00 Mnthly Service Fee: $10.00 By signing belw, I reaffirm my acceptance f the terms and cnditins applicable t ARB set frth in Appendix C, Value- Adding Services, f the Authrize.Net Payment Gateway Agreement. MERCHANT: Signature: Print Name: Business Name: 2009 Authrize.Net, a CyberSurce slutin Attn: Lisa Millar P A G E 5 O F 6

6 APPENDIX A: MERCHANT ACCOUNT CONFIGURATION FORM IMPORTANT: Appendix A must be cmpleted by merchants with active Merchant Accunts. Cmpany Name: STEP 1: Credit Card Types that yur Merchant Accunt is Currently Cnfigured t Accept Accepted Cards (select all that apply): Visa/MasterCard American Express Discver Diner s Club JCB Enrute STEP 2: Merchant Accunt Prcessr Cnfiguratin Infrmatin Instructins: Please prvide the requested infrmatin fr the prcessr that is assciated with yur merchant accunt. Yu need nly prvide infrmatin fr ONE prcessr. If yu d nt knw this infrmatin, please cntact Lisa Millar at Chase Paymentech Tampa Platfrm Client (4 digits): Merchant # (Gensar #) (12 digits): Terminal # (TID) (3 digits): FDMS Cncrd EFSNet BuyPass / Terminal # (TID) (6 digits): Merchant ID (MID) (2 digits): First Data Merchant Services (FDMS) Nashville Platfrm Merchant ID (MID) (6-7 digits): Terminal ID (TID) (6-7 digits): First Data Merchant Services (FDMS) Omaha Platfrm Merchant ID (MID) (15 r 16 digits): Glbal Payments East Platfrm Acquirer Inst. ID (Bank ID) (6 digits): Merchant ID (MID) (Usually 16 digits): Elavn (frmerly Nva) Bank # / Term BIN (6 digits): Terminal ID (TID) (16 digits): Pay By Tuch (frmerly CardSystems) Acquirer BIN (6 digits): Terminal ID (TID) (10 digits): RBS Lynk (frmerly LynkSystems) Acquirer BIN (6 digits): Stre # (4 digits): Terminal # (TID) (4 digits): Merchant # (12 digits): Merchant Categry Cde (4 digits): Market Type (select ne): E-Cmmerce MOTO Retail TSYS Acquiring Slutins (frmerly Vital) Acquirer BIN (6 digits): Agent Bank # (6 digits): Agent Chain # (6 digits): Categry Cde (4 digits): Terminal # (TID) (4 digits): Stre # (4 digits): Merchant # (12 digits): 2009 Authrize.Net, a CyberSurce slutin Attn: Lisa Millar P A G E 6 O F 6